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NOTE: Medicare premiums are subject to payment by a third party. For an institutional case in which the customer is not an SSI recipient and will not receive a reimbursement for Medicare cost from any source, deduct the Medicare premium as an expense for months immediately preceding the second month after the month of approval. Example #1 (Medicaid Only): Customer applied June 2nd and requested 3 months prior medical. Case is approved July 10th. Deduct Medicare premiums from March through August. Beginning September do not deduct the Medicare premium, as it is then subject to third–party payments. Example #2 (Medicaid/QMB): Customer applied for Medicaid/QMB on June 2nd and requested 3 months prior medical. In June, QMB eligibility is established, and benefits begin effective July 1st. Then, on July 20th Medicaid eligibility is established back to March. Deduct Medicare premiums for March, April, May and June only. Effective July and ongoing, the premiums are subject to third–party payments as QMB coverage began in July. 6. Expenses Incurred For Medical Care Deduct expenses incurred by the customer for necessary medical care recognized under the state law but not covered under the Medicaid Program. This includes medical expenses incurred more than three months prior to the date of application. Customer/Representatives must advise the agency and submit proof of the expenses. The case manager must attach a copy of the medical bill plus all related medical records to Form-2536 and submit it to DHCFP for approval. These expenses must not be paid or subject to payment by a third party. DHCFP approval is required to assure the deduction is for necessary care payable to reasonable limits. c. The deficit, if any, is the customer’s share of facility cost (PATIENT LIABILITY). F-120.5 LONG TERM CARE SERVICES Division of Social Services Medical Assistance Manual 08 Aug MTL 08/25 Patient Liability Budgeting Procedures – Form2220­ EM/A